How to Use Central Neuromodulators (CNs) to Help Manage Patients with Disorders of Gut-Brain Interaction (DGBI)

  • W. Harley Sobin


This article instructs on the use of central neuromodulators to manage patients with chronic functional gastrointestinal disorders that are incompletely responding to dietary changes or peripherally acting gastrointestinal drugs. The use of various psychopharmacologic agents, including SSRIs, SNRIs, TCAs, other antidepressants, and second-generation antipsychotics, is reviewed. The benefit of these agents in managing chronic abdominal pain, nausea, dyspepsia, and altered bowel function is discussed. Case studies are provided. Dosages of the agents and potential side effects are discussed. In addition, a set of questions and answers to drive home salient clinical points is included, as an addendum.


Disorders of gut-brain interaction (DGBI) Functional gastrointestinal disorders (FGID) Irritable bowel syndrome (IBS) Central neuromodulators Antidepressants Abdominal pain Dyspepsia Nausea Psychopharmacology 


  1. 1.
    Clouse RE, Lustman PJ. Use of psychopharmacological agents for functional gastrointestinal disorders. Gut. 2005;54(9):1332–41. Scholar
  2. 2.
    Dekel R, Drossman DA, Sperber AD. The use of psychotropic drugs in irritable bowel syndrome. Expert Opin Investig Drugs. 2013;22(3):329–39. Scholar
  3. 3.
    Drossman DA, Tack J, Ford AC, Szigethy E, Törnblom H, Van Oudenhove L. Neuromodulators for functional gastrointestinal disorders (disorders of gut−brain interaction): a Rome foundation working team report. Gastroenterology. 2018;154:1140–1171.e1. Scholar
  4. 4.
    Grover M, Drossman DA. Psychopharmacologic and behavioral treatments for functional gastrointestinal disorders. Gastrointest Endosc Clin N Am. 2009;19(1):151–70. Scholar
  5. 5.
    Van Oudenhove L, Levy RL, Crowell MD, et al. Biopsychosocial aspects of functional gastrointestinal disorders: how central and environmental processes contribute to the development and expression of functional gastrointestinal disorders. Gastroenterology. 2016;150(6):1355–1367.e2. Scholar
  6. 6.
    Kim SE, Chang L. Overlap between functional GI disorders and other functional syndromes: what are the underlying mechanisms? Neurogastroenterol Motil. 2012;24(10):895–913. Scholar
  7. 7.
    Mayer EA, Tillisch K. The brain-gut axis in abdominal pain syndromes. Annu Rev Med. 2011;62:381–96. Scholar
  8. 8.
    Keefer L, Drossman DA, Guthrie E, et al. Centrally mediated disorders of gastrointestinal pain. Gastroenterology. 2016;150(6):1408–19. Scholar
  9. 9.
    Stahl SM. Stahl’s essential psychopharmacology. 4th ed. Cambridge: Cambridge University Press; 2013.Google Scholar
  10. 10.
    Schatzberg AF, DeBattista C. Manual of clinical psychopharmacology. Washington, DC: American Psychiatric Publishing; 2015. Accessed 26 Nov 2015.CrossRefGoogle Scholar
  11. 11.
    Creed F. How do SSRIs help patients with irritable bowel syndrome? Gut. 2006;55(8):1065–7. Scholar
  12. 12.
    Grover M, Drossman DA. Psychotropic agents in functional gastrointestinal disorders. Curr Opin Pharmacol. 2008;8(6):715–23. Scholar
  13. 13.
    Grover M, Drossman DA. Centrally acting therapies for irritable bowel syndrome. Gastroenterol Clin N Am. 2011;40:183–206. Scholar
  14. 14.
    Törnblom H, Drossman DA. Centrally targeted pharmacotherapy for chronic abdominal pain. Neurogastroenterol Motil. 2015;27(4):455–67. Scholar
  15. 15.
    Drossman DA, Toner BB, Whitehead WE, et al. Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology. 2003;125(1):19–31. Accessed 26 Nov 2015.CrossRefGoogle Scholar
  16. 16.
    Tack J, Ly HG, Carbone F, et al. Efficacy of mirtazapine in patients with functional dyspepsia and weight loss. Clin Gastroenterol Hepatol. 2016;14(3):385–392.e4. Scholar
  17. 17.
    Jiang SM, Jia L, Liu J, Shi MM, Xu MZ. Beneficial effects of antidepressant mirtazapine in functional dyspepsia patients with weight loss. World J Gastroenterol. 2016;22:5260–6. Scholar
  18. 18.
    Tack J, Janssen P, Masaoka T, Farré R, Van Oudenhove L. Efficacy of buspirone, a fundus-relaxing drug, in patients with functional dyspepsia. Clin Gastroenterol Hepatol. 2012;10(11):1239–45. Scholar
  19. 19.
    Coss-Adame E, Erdogan A, Rao SSC. Treatment of esophageal (noncardiac) chest pain: an expert review. Clin Gastroenterol Hepatol. 2014;12(8):1224–45. Scholar
  20. 20.
    Clouse RE, Lustman PJ, Eckert TC, Ferney DM, Griffith LS. Low-dose trazodone for symptomatic patients with esophageal contraction abnormalities. A double-blind, placebo-controlled trial. Gastroenterology. 1987;92(4):1027–36. Accessed 26 Nov 2015.CrossRefGoogle Scholar
  21. 21.
    Grover M, Dorn SD, Weinland SR, Dalton CB, Gaynes BN, Drossman DA. Atypical antipsychotic quetiapine in the management of severe refractory functional gastrointestinal disorders. Dig Dis Sci. 2009;54(6):1284–91. Scholar
  22. 22.
    Sobin WH, Heinrich TW, Drossman DA. Central neuromodulators for treating functional GI disorders: a primer. Am J Gastroenterol. 2017;112:693–702. Scholar
  23. 23.
    Sperber AD, Drossman DA. Review article: the functional abdominal pain syndrome. Aliment Pharmacol Ther. 2011;33:514–24. Scholar
  24. 24.
    Loke YK, Trivedi AN, Singh S. Meta-analysis: gastrointestinal bleeding due to interaction between selective serotonin uptake inhibitors and non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther. 2007;27(1):31–40. Scholar
  25. 25.
    Anglin R, Yuan Y, Moayyedi P, Tse F, Armstrong D, Leontiadis GI. Risk of upper gastrointestinal bleeding with selective serotonin reuptake inhibitors with or without concurrent nonsteroidal anti-inflammatory use: a systematic review and meta-analysis. Am J Gastroenterol. 2014;109(6):811–9. Scholar
  26. 26.
    Richter JA, Patrie JT, Richter RP, et al. Bleeding after percutaneous endoscopic gastrostomy is linked to serotonin reuptake inhibitors, not aspirin or clopidogrel. Gastrointest Endosc. 2011;74(1):22–34.e1. Scholar
  27. 27.
    Thiwan S, Drossman DA, Morris CB, et al. Not all side effects associated with tricyclic antidepressant therapy are true side effects. Clin Gastroenterol Hepatol. 2009;7(4):446–51. Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • W. Harley Sobin
    • 1
  1. 1.Pleasant PrairieUSA

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